Articles: nerve-block.
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A 72-yr-old patient was to undergo a left lumbar plexus block by the posterior approach to achieve postoperative analgesia after hip replacement. The block failed after three unsuccessful attempts to identify nerve structures and a fascia iliaca compartment block was performed. ⋯ She was re-admitted 2 weeks after surgery because of a lower limb motor deficit and a left retroperitoneal haematoma requiring blood transfusion. Clinicians need to be aware of this potential complication of lumbar plexus block in patients receiving thrombphylaxis.
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Int J Obstet Anesth · Oct 2004
Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries.
A retrospective analysis was performed on 19,259 deliveries that occurred in our institution from January 2000 to December 2002. Anesthesia records and quality assurance data sheets were reviewed for the characteristics and failure rates of neuraxial blocks performed for labor analgesia and anesthesia. The neuraxial labor analgesia rate was 75% and the overall failure rate was 12%. ⋯ The overall use of general anesthesia decreased from 8% to 4.3% over the three-year period. Furthermore, regional anesthesia was used in 93.5% of cesarean deliveries with no anesthetic-related mortalities. Future investigations should identify acceptable international standards, risk factors associated with failure and methods to reduce failure before cesarean section.
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In recent years there has been a renewed interest in regional anaesthesia, particularly peripheral nerve blockade, not only to improve the patient's well being, but also to meet the requirements of modern orthopaedic surgery. Nerve injury in this context is the complication most feared by the patient, the anaesthesiologist and the surgeon. ⋯ Significant advances have been made in regional anaesthesia in the past 10 years. The introduction of catheter techniques has cleared the way for better regional anaesthetic and analgesic blocks. Studies dealing with placement of perineural catheters show that the catheter does not increase neurological complications. Properly performed, regional anaesthesia is a safe form of anaesthesia and the benefits far outweigh the risks.
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Success of plexus nerve block is most dependent upon the correct positioning of the local anaesthetic solution within proximity to the corresponding nerve trunk. With the aim of verifying the close approximation of needle and nerve, and increasing the corresponding success rate, in the course of the history of regional anaesthesia, and in addition to the classical methods like seeking of paraesthesia, different mechanical aids have been used for nerve detection. In the last two decades, important medical diagnostic and therapeutic advances in imaging technology have been presented. In this review we will analyse the role such imaging diagnostic procedures will play in regional anaesthesia practice. ⋯ In this paper we will analyse which imaging techniques are of relevance to anaesthesia in terms of clinical outcome, research and teaching of regional anaesthetic techniques, and the clinical impact of such imaging techniques upon anaesthesia practice.